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Monday, August 19, 2013

Nitty Gritty of the Affordable Care Act - There Is a Way: Medicare for All

There's clearly a way out, a light to focus on, for the policy leaders and consumer advocates who are understandably anxious about enrolling the uninsured into health insurance exchanges on October 1, 2013, when the Affordable Care Act begins.  It's called Medicare for All. It's a damn shame we don't have this desirable option to offer everyone come October 1, 2013, when people need it.  

Shame on short sighted Republicans, who are too greedy on behalf of their rich insurance executive supporters, to expand what already works, so everybody who needs the security of a health insurance safety net, can receive coverage.  

A forum on the Affordable Care Act (ACA), providing information from an expert panel, about how health insurance exchange enrollments will be rolled out in Maine, was presented in all its "nitty-gritty" detail this afternoon at the University of Southern Maine's symposium, presented by the Muskie Center. 

The health insurance exchanges are online marketplaces for individuals who aren’t otherwise covered by employer-sponsored insurance plans, Medicare or Medicaid. Some small businesses also will buy exchange plans to cover their employees. According to the Congressional Budget Office, about 85 percent of those expected to sign up for insurance through the exchanges this year will qualify for federal subsidies to help them afford their monthly premiums.
In the USM audience of about 130 people were many professionals who monitored the complex information for various provider and consumer groups.  It took a professional actuary to figure out what the experts on the panel explained.  In short, this ACA enrollment, beginning on October 1, 2013 and extending thru March 1, 2014, will have "bumps along the way", as stated by Trish Riley, the panel moderator from the Muskie Center.  In my opinion, these bumps would be more like curves in the road if Medicare for All were the outcome of the ACA enrollment.

Instead, the audience was shown a detailed Excel spreadsheet matrix with 60 cells filled with tiny print.  Already, at the outset, we can't read the fine print and we've hardly started.  

But, (!) were told, we'd be given a website address for the tiny print matrix,  so we could go to the page to read the words. Meanwhile, almost every audience member had either an iPad or a computer laptop so, given the website address, many could have accessed the detailed chart for the purpose of figuring out what it said. Nevertheless, the website address would be given later, we were told.  Consequently we had to listen to an expert or two on the panel to explain what we could not read because the fine print was entirely too small.  

What it boils down to is "nitty gritty"  "bumps in the road", all of it avoidable, if all Americans could  be given access to Medicare. (This is my value added opinion, not that of the symposium.)

There's absolutely no reason whatsoever why all Americans who pay Social Security and Medicare taxes shouldn't have access to the same health insurance benefits as those who qualify, at age 65 and over.  Medicare is not free.  It's paid for throughout our working lives and while we're on the benefit. Beneficiaries pay, even after enrollment at 65 years of age, for those who qualify by having paid the 40 quarters into the Social Security benefit, through FICA tax.  

Most important, Medicare for All doesn't require beneficiaries to read the fine print to figure out if they qualify for the precious metal levels of care including "bronze" or "silver" etc., or the "catastrophic coverage" plans.   Each of the insurance exchange choices has a group of fine print Excel blocks dedicated to the coverage, to explain the shared risk and/or pre-tax or post tax credit options.  

"A tax credit can be received up front, and it can go directly to an insurance company to immediately discount your monthly payment," Riley says, "so your out-of-pocket expenses for monthly payments are significantly reduced."

Unfortunately, on January 1, 2014, Maine's 70,000 people who won't qualify for Medicaid will be required to participate in one of the two insurance exchanges offered in the state through either one (a) Maine Community Health Options or (b) Anthem provider programs, unless their employer participates in the ACA, on their behalf, or they have another health insurance carrier.

Riley says the people who need to sit up and pay the most attention to the health insurance exchanges right now are those who will use the online insurance marketplace - in other words, those who don't have health insurance right now, or whose coverage is too expensive. That's estimated to be nearly 170,000 people in Maine, and Riley says the law uses a carrot-and-stick approach to encourage them to sign up.  

"Importantly, the Affordable Care Act not only creates discounts to premiums, but limits how much out-of-pocket exposure people have when they use health care," Riley says.

"Navigators" have been trained to help people make the choices most beneficial to them, and these people will be located at Community Health Centers and other central sites throughout Maine.

But one bump in the implementation of the Affordable Care Act in Maine is already emerging: Those whose incomes are at, or less than, the poverty level are actually not eligible for tax credits.

"So the poorest of the poor will get nothing, and will remain uninsured," Riley says. "That's because the Afforable Care Act originally assumed Medicaid - here in Maine, the MaineCare program - would cover all poor people. The Supreme Court said, 'No,' that was up to states."  And Maine's Governor vetoed the bi-partisan bill passed to provide this coverage.  

For the brave hearts who would like to figures out the health insurance exchange options for themselves or someone who needs the coverage, the website to begin the process is:  

This site provides access to e-mail and text updates about the Health Insurance Marketplace.  It'll help consumers to find health coverage that fits their budget and meet their needs.  Whether a person is uninsured or just wants to explore their choices, the marketplace can help find a plan that's right.  It's important to begin this process by October 1, 2013.  

Also, call this 1-800-318-2596 or TTY 1-855-889-4315 for more information.

And, given the opportunity to enter any questions, please - paaaleeeze- find a way to ask why we can't all participate in Medicare for All!

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